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Improved medical care has led to an increase in both the age and clinical complexity of patients admitted to Internal Medicine wards, characterized by multiple chronic diseases. Multimorbidity is a common issue in the elderly, significantly associated with higher mortality, functional decline, and poorer quality of life. The concept of "disease clustering" goes beyond simple multimorbidity or comorbidity by grouping statistically associated morbid conditions to understand their interconnections, shared risk factors, and pathophysiological mechanisms. The goal is to identify these clusters in relation to the most common chronic conditions in Internal Medicine: heart failure, chronic obstructive pulmonary disease (COPD), and chronic kidney disease.This is an observational, multicenter, prospective, national study sponsored by the FADOI Foundation (Federation of Associations of Internal Medicine Hospital) and this is a non-profit research project. It aims to involve about 50 Internal Medicine Units, targeting the enrollment of approximately 100 consecutive adult patients per unit, for a total of at least 1500 subjects per pathology group.
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| Measure | Description | Time Frame |
|---|---|---|
| Identifying disease clusters (defined as the co-presence of at least two additional diseases) in patients suffering from at least one of the following chronic diseases: heart failure, COPD, and chronic kidney disease | IN-CluDiMI study primary objective was to map the structural patterns of disease clustering around HF, COPD, and CKD, and to evaluate their prevalence, functional impacts, and geographic distribution.We also investigated the prognostic role of these clusters on mortality (in-hospital and/or follow-up mortality). The analysis included all available comorbidities, excluding highly prevalent risk factors such as hypertension, diabetes mellitus and dyslipidaemia, which were analysed separately. The optimal number of clusters was determined using the silhouette index, selecting a solution that maximised cluster separation and internal cohesion. 3 complementary approaches were used to investigate co-occurrence patterns:
| 14 Months |
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Inclusion Criteria:
Exclusion Criteria:
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53 Internal Medicine Units, and for each of them the enrollment of approximately 100 consecutively hospitalized adult patients affected by at least one chronic disease among heart failure, COPD and chronic renal failure in the Medicine Units is planned, for a total of at least 1500 subjects per disease group
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| Name | Affiliation | Role |
|---|---|---|
| Ombretta Para, PhD | Department of Medicine, AOU Careggi, Firenze | Study Chair |
| Francesco Dentali, Prof. | Department of Medicine, ASST-Settelaghi, Varese | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Antonella Valerio | Roma | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21209965 | Background | Schafer I, von Leitner EC, Schon G, Koller D, Hansen H, Kolonko T, Kaduszkiewicz H, Wegscheider K, Glaeske G, van den Bussche H. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010 Dec 29;5(12):e15941. doi: 10.1371/journal.pone.0015941. | |
| 30171585 |
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The following information collected for each patient:
Demographic parameters
Medical history
-Pathology (home, nursing home), hospitalizations in the previous year/month, basic activities of daily living (BADL/IADL) autonomy, Barthel scale score
History of medical conditions Heart failure (NYHA class), COPD, renal failure (the severity), hypertension, asthma, diabetes mellitus (with/without organ damage), chronic anemia, dislipidemia, active solid tumor (pharmacological/radiotherapy treatment), active hematological oncology (pharmacological/radiotherapy treatment), ischemic heart disease, atrial fibrillation, cerebrovascular disease (TIA/stroke), Parkinson's disease/neurodegenerative disease, thyroid diseases
Medications/Treatments
-Number and class of medications taken before hospital admission/discharge
Charlson Index Score
Hospitalization Outcome
-Discharge (home/nursing home), death, transfer to intensive care
30-day phone follow-up Mortality and rehospitalization 30days
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| Mannucci PM, Nobili A, Pasina L; REPOSI Collaborators (REPOSI is the acronym of REgistro POliterapie SIMI, Societa Italiana di Medicina Interna). Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern Emerg Med. 2018 Dec;13(8):1191-1200. doi: 10.1007/s11739-018-1941-8. Epub 2018 Aug 31. |
| 34557797 | Background | Bisquera A, Gulliford M, Dodhia H, Ledwaba-Chapman L, Durbaba S, Soley-Bori M, Fox-Rushby J, Ashworth M, Wang Y. Identifying longitudinal clusters of multimorbidity in an urban setting: A population-based cross-sectional study. Lancet Reg Health Eur. 2021 Mar 2;3:100047. doi: 10.1016/j.lanepe.2021.100047. eCollection 2021 Apr. |
| 32210388 | Background | Whitty CJM, Watt FM. Map clusters of diseases to tackle multimorbidity. Nature. 2020 Mar;579(7800):494-496. doi: 10.1038/d41586-020-00837-4. No abstract available. |
| ID | Term |
|---|---|
| D006333 | Heart Failure |
| D029424 | Pulmonary Disease, Chronic Obstructive |
| D051436 | Renal Insufficiency, Chronic |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
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